September 7, 2010: The U.S. Marine Corps has joined the U.S. Army in expanding its counseling and mental health efforts to cope with the growing number of combat veterans seeking help with stress related issues. The problem is huge and growing, and there are two main indicators, the most publicized one being the suicide rate. It has gone from 9 per 100,000 troops in 2001, to 24 for the marines and 22 for the army, and this gets most of the media attention. When adjusted for age, gender and so on, the rate for civilian counterparts to soldiers and marines is about 19 per 100,000. Normally, the rates for military personnel are lower, because recruiters select people who are better able to handle stress. The air force and navy have not had nearly as many personnel in the combat zones and their suicide rates are lower (at 15.5 and 13.3 respectively)

The less noticed indicator, which impacts a lot more people, is the use of anti-stress medications. These have gone up, for the army, 76 percent since 2001. About 17 percent of all soldiers now take these drugs, including six percent of those in combat zones. In 2001, the troops used these drugs to about the same degree as the civilian population (ten percent.) The impact of these drugs, especially in combination, can be unpredictable. The army is still waiting to see how this increased use of anti-stress medications will play out. This is all unknown territory, and the marines are seeing the same problems as the army.

The losses to stress are growing. For example, for every soldier killed, one is sent back home for treatment of acute stress. For every one of those cases, there are several less serious ones that are treated in the combat zone. It's increasingly more common to have troops being sent back to the combat zone, even though they are showing symptoms of PTSD  (post-traumatic stress disorder). Often, the troops want to go, out of a sense of duty, patriotism, pride or, most commonly, a sense of not wanting to let their fellow soldiers down. Senior commanders have some discretion in setting the minimum standard of psychological fitness for troops deployed, and they depend on reports from the combat zone, of soldiers with some PTSD and how they do while back in combat.

Many of these stressed troops are no longer able to perform all their duties. This is sometimes the case with troops taking anti-stress drugs. Some of these medications slow you down, which can be fatal if you find yourself in combat, or an emergency situation. Many troops on these medications are no longer sent overseas. Mainly because they can perform well back in the United States, but the medication side effects complicate the job of finding enough troops to go to combat zones.

All this was seen as an inevitable result of so many NCOs and officers doing their third or fourth combat tours (in Iraq or Afghanistan). Thus a PTSD epidemic has been created by the unprecedented exposure of so many troops, to so much combat, in so short a time. Once a soldier has PTSD, they are often no longer fit for combat, and many troops headed for Afghanistan are falling into this category. PTSD makes it difficult for people to function, or get along with others. With treatment (medication, and therapy), you can recover from PTSD. But this can take months or years.

Nearly a century of energetic effort to diagnose and treat PTSD (including much recent attention to civilian victims, via accidents or criminal assault), had made it clear that most troops eventually got PTSD if they were in combat long enough. During World War II, it was found that, on average, 200 days of combat would bring on a case of PTSD for American troops. After World War II, methods were found to delay the onset of PTSD (more breaks from combat, better living conditions in the combat zone, prompt treatment when PTSD was detected). That's why combat troops in Iraq and Afghanistan often sleep in air conditioned quarters, have Internet access, lots of amenities, and a two week vacation (anywhere) in the middle of their combat tour. This has extended their useful time in combat, before PTSD sets in. No one is yet sure what the new combat days average is, and new screening methods are an attempt to find out. But more troops appear to be hitting, or approaching, the limits.

What the army does know is that a large percentage of its combat troops have over 200 days of combat. Some have three or four times that. A major reason for army generals talking about the army "needing a break" (from combat) is the growing loss of many combat experienced troops and leaders (especially NCOs) to PTSD. The army won't give out exact figures, partly because they don't have much in the way of exact figures. But over the next decade, the army will get a clearer picture of how well they have coped with PTSD, among troops who have, individually, seen far more combat than their predecessors in Vietnam, Korea or World War II. And there is growing evidence that PTSD that doesn't show up while the troops are still in uniform, often manifests itself decades later. This was seen with elderly World War II and Korean War vets, and is showing up with Vietnam war vets as well. Part of this is due to better diagnostic tools for detecting long term PTSD effects. While this is producing some scary statistics, it also makes it easier to treat what would be passed off as mental problems associated with old age.

The army and marines are dealing with PTSD head on. When someone does come down with it, PTSD can often be treated, and its effects reversed. This has large ramifications for non-military medicine, for many civilians suffer from PTSD. That's why military recruits are screened for their ability to handle stress and resist PTSD. In the civilian community, there are far more people who can acquire PTSD after exposure to much less stress.